Multidisciplinary intervention to improve medication safety in nursing home residents: protocol of a cluster randomised controlled trial (HIOPP-3-iTBX study).
Accidental Falls
/ prevention & control
Aged
Aged, 80 and over
Cluster Analysis
Drug-Related Side Effects and Adverse Reactions
/ epidemiology
Female
Follow-Up Studies
General Practitioners
/ standards
Germany
/ epidemiology
Humans
Inappropriate Prescribing
/ prevention & control
Male
Nursing Homes
/ standards
Patient Care Team
/ standards
Pharmacists
/ standards
Polypharmacy
Potentially Inappropriate Medication List
/ standards
Quality of Life
/ psychology
Change management
General practitioners
Interprofessional
Medication review
Medication therapy management
Nursing homes
Nursing staff
Pharmacists
Polypharmacy
Journal
BMC geriatrics
ISSN: 1471-2318
Titre abrégé: BMC Geriatr
Pays: England
ID NLM: 100968548
Informations de publication
Date de publication:
25 01 2019
25 01 2019
Historique:
received:
04
12
2018
accepted:
04
01
2019
entrez:
27
1
2019
pubmed:
27
1
2019
medline:
20
11
2019
Statut:
epublish
Résumé
Medication safety is an important health issue for nursing home residents (NHR). They usually experience polypharmacy and often take potentially inappropriate medications (PIM) and antipsychotics. This, coupled with a frail health state, makes NHR particularly vulnerable to adverse drug events (ADE). The value of systematic medication reviews and interprofessional co-operation for improving medication quality in NHR has been recognized. Yet the evidence of a positive effect on NHR' health and wellbeing is inconclusive at this stage. This study investigates the effects of pharmacists' medication reviews linked with measures to strengthen interprofessional co-operation on NHR' medication quality, health status and health care use. Pragmatic cluster randomised controlled trial in nursing homes in four regions of Germany. A total of 760 NHR will be recruited. Inclusion: NHR aged 65 years and over with an estimated life expectancy of at least six months. Intervention with four elements: i) introduction of a pharmacist's medication review combined with a communication pathway to the prescribing general practitioners (GPs) and nursing home staff, ii) facilitation of change in the interprofessional cooperation, iii) educational training and iv) a "toolbox" to facilitate implementation in daily practice. primary outcome - proportion of residents receiving PIM and ≥ 2 antipsychotics at six months follow-up. Secondary outcomes - cognitive function, falls, quality of life, medical emergency contacts, hospital admissions, and health care costs. The trial assesses the effects of a structured interprofessional medication management for NHR in Germany. It follows the participatory action research approach and closely involves the three professional groups (nursing staff, GPs, pharmacists) engaged in the medication management. A handbook based on the experiences of the trial in nursing homes will be produced for a rollout into routine practice in Germany. Registered in the German register of clinical studies (DRKS, study ID DRKS00013588 , primary register) and in the WHO International Clinical Trials Registry Platform (secondary register), both on 25th January 2018.
Sections du résumé
BACKGROUND
Medication safety is an important health issue for nursing home residents (NHR). They usually experience polypharmacy and often take potentially inappropriate medications (PIM) and antipsychotics. This, coupled with a frail health state, makes NHR particularly vulnerable to adverse drug events (ADE). The value of systematic medication reviews and interprofessional co-operation for improving medication quality in NHR has been recognized. Yet the evidence of a positive effect on NHR' health and wellbeing is inconclusive at this stage. This study investigates the effects of pharmacists' medication reviews linked with measures to strengthen interprofessional co-operation on NHR' medication quality, health status and health care use.
METHODS
Pragmatic cluster randomised controlled trial in nursing homes in four regions of Germany. A total of 760 NHR will be recruited. Inclusion: NHR aged 65 years and over with an estimated life expectancy of at least six months. Intervention with four elements: i) introduction of a pharmacist's medication review combined with a communication pathway to the prescribing general practitioners (GPs) and nursing home staff, ii) facilitation of change in the interprofessional cooperation, iii) educational training and iv) a "toolbox" to facilitate implementation in daily practice.
ANALYSIS
primary outcome - proportion of residents receiving PIM and ≥ 2 antipsychotics at six months follow-up. Secondary outcomes - cognitive function, falls, quality of life, medical emergency contacts, hospital admissions, and health care costs.
DISCUSSION
The trial assesses the effects of a structured interprofessional medication management for NHR in Germany. It follows the participatory action research approach and closely involves the three professional groups (nursing staff, GPs, pharmacists) engaged in the medication management. A handbook based on the experiences of the trial in nursing homes will be produced for a rollout into routine practice in Germany.
TRIAL REGISTRATION
Registered in the German register of clinical studies (DRKS, study ID DRKS00013588 , primary register) and in the WHO International Clinical Trials Registry Platform (secondary register), both on 25th January 2018.
Identifiants
pubmed: 30683060
doi: 10.1186/s12877-019-1027-0
pii: 10.1186/s12877-019-1027-0
pmc: PMC6347799
doi:
Banques de données
DRKS
['DRKS00013588']
Types de publication
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
24Investigateurs
Simone Bernard
(S)
Stefanie Kortekamp
(S)
Angela Fuchs
(A)
Achim Mortsiefer
(A)
Anja Wollny
(A)
Attila Altiner
(A)
Hannah Haumann
(H)
Stefanie Joos
(S)
Nils Schneider
(N)
Thomas G Grobe
(TG)
Christian Günster
(C)
Références
J Clin Psychiatry. 2017 Jan;78(1):e76-e82
pubmed: 28129493
Dtsch Arztebl Int. 2010 Aug;107(31-32):543-51
pubmed: 20827352
PLoS One. 2016 Feb 03;11(2):e0146811
pubmed: 26840396
BMC Geriatr. 2017 Sep 19;17(1):220
pubmed: 28927372
J Am Med Dir Assoc. 2018 Jan;19(1):46-52
pubmed: 28899661
BMC Geriatr. 2011 Apr 17;11:16
pubmed: 21496345
BMC Fam Pract. 2016 Aug 30;17(1):123
pubmed: 27576357
BMC Geriatr. 2017 Jan 26;17(1):35
pubmed: 28125977
Cochrane Database Syst Rev. 2016 Feb 12;2:CD009095
pubmed: 26866421
J Am Med Dir Assoc. 2012 Feb;13(2):187.e7-187.e13
pubmed: 21549645
Appl Nurs Res. 2017 Jun;35:118-125
pubmed: 28532718
J Psychiatr Res. 1975 Nov;12(3):189-98
pubmed: 1202204
Z Gerontol Geriatr. 2001 Aug;34(4):306-12
pubmed: 11584715
Md State Med J. 1965 Feb;14:61-5
pubmed: 14258950
BMC Geriatr. 2017 Jan 18;17(1):24
pubmed: 28100176
Expert Opin Drug Saf. 2014 Jan;13(1):57-65
pubmed: 24073682
CMAJ. 2005 Aug 30;173(5):489-95
pubmed: 16129869
Implement Sci. 2015 Jun 04;10:82
pubmed: 26037324
Age Ageing. 2017 Mar 1;46(2):291-299
pubmed: 27836856
Br J Clin Pharmacol. 2014 Sep;78(3):488-97
pubmed: 24548138
Z Gerontol Geriatr. 2004 Aug;37(4):316-26
pubmed: 15338161
J Am Geriatr Soc. 2016 Jun;64(6):1203-9
pubmed: 27321599
BMC Geriatr. 2017 Jan 26;17(1):32
pubmed: 28122506
Ann Intern Med. 2017 Nov 7;167(9):609-617
pubmed: 29052691
Br J Gen Pract. 2012 May;62(598):e329-36
pubmed: 22546592
Z Evid Fortbild Qual Gesundhwes. 2012;106(10):712-6
pubmed: 23217723
Dtsch Arztebl Int. 2016 Feb 12;113(6):92-8
pubmed: 26931625
Z Evid Fortbild Qual Gesundhwes. 2016;113:27-35
pubmed: 27480186
BMJ. 2001 Sep 29;323(7315):746-9
pubmed: 11576986
BMC Fam Pract. 2017 Jan 17;18(1):5
pubmed: 28095780
J Am Med Dir Assoc. 2013 Jul;14(7):471-8
pubmed: 23566932
Implement Sci. 2016 Mar 11;11:35
pubmed: 26968520
Br J Clin Pharmacol. 2015 Oct;80(4):796-807
pubmed: 25619317